ECMO支持危重症病人院内转运不良事件的系统评价

ECMO supports adverse events of in-hospital transport of critically ill patients:a systematic review

目的:系统评价体外膜肺氧合(ECMO)支持危重症病人院内转运发生不良事件的危险因素,为预防不良事件提供依据。方法:通过计算机检索中国知网(CNKI)、万方数据库、维普数据库、中国生物医学文献数据库、PubMed,EMbase,CINAHL,theCochrane Library等。检索时限均为各数据库建库至2020年12月31日。采用主题词和自由词相结合的方式检索ECMO支持危重症病人院内转运发生不良事件的危险因素。由2位研究员独立筛选文献,提取文献资料及质量评价,描述性分析纳入文献的危险因素。结果:共纳入文献17篇,其中个案研究8篇,病例系列研究9篇;质量评价高质量4篇(23.53%),中质量6篇(35.59%),低质量7篇(41.17%);不良事件等级:一级不良事件3例(11.54%),二级不良事件8例(30.77%),三级不良事件15例(57.69%);不良事件类型:与转运人员有关8例(30.77%),与转运设备有关14例(53.85%),与病人有关4例(15.38%)。结论:现有证据表明,设备因素是发生不良事件的主要危险因素,病人病情变化是不良事件的危险因素,转运团队和组织因素影响安全转运。

Objective:To systematically evaluate the risk factors of adverse events in ECMO supporting the in-hospital transport of critically ill patients,and to provide evidence for the prevention of adverse events.Methods:Articles on ECMO-supported risk factors for in-hospital transport of critically ill patients were retrieved from CNKI,WanFang Database,VIP,CBM,PubMed,CINAHL,EMbase the Cochrane Library,etc.The search time limit was for each database to be built until December 31,2020.The combination of subject words and free words was used for retrieval.The literature screening and extraction,quality evaluation,and the risk factors of the included literature were descriptive analysis of carrid out by two researchers independently.Results:A total of 17 literatures were included,including 8 case studies and 9 case series studies.Quality evaluation:high quality 4(23.53%),medium quality 6(35.59%),low quality 7(41.17%);The level of adverse events was 1(11.54%),2(30.77%),and 3(57.69%).Types of adverse events:8 cases(30.77%)related to transport personnel,14 cases(53.85%)related to transport equipment,and 4 cases(15.38%)related to patients.Conclusions:Existing evidence indicates that equipment factors are the main risk factors for adverse events,patient condition changes are the risk factors for adverse events,and transport team and organizational factors affect safe transport.